Get the free printed: 07/20/2022 form approved
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PRINTED: 07/20/2022
FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA
IDENTIFICATION
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Printed 0720 form approved is a tax form used for reporting certain information to the IRS.
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